摘要
目的探讨腹腔镜胆囊切除术与腹腔镜辅助胆管镜保胆取石术对老年胆囊结石患者术后应激反应及肝功能的影响以及疗效的差异。方法选取2013年6月—2015年12月在郑州市人民医院就诊的老年胆囊结石患者102例,按照手术方式分为胆囊切除组62例(行腹腔镜胆囊切除术)和保胆取石组40例(行腹腔镜辅助胆管镜保胆取石术)。记录并比较两组患者术后排气时间、镇痛剂使用情况、围术期并发症发生情况及住院时间;比较两组术前1 d及术后1、3、7 d血糖、C反应蛋白(CRP)水平及肝功能指标[包括丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、总蛋白(TP)和总胆红素(TBIL)]。统计并比较两组术后结石复发、并发症发生情况。两组患者随访时间截至2016-12-30。结果保胆取石组镇痛剂使用率低于胆囊切除组(P<0.05);治疗方法与时间在血糖、CRP水平上存在交互作用(P<0.05);治疗方法、时间在血糖、CRP水平上主效应显著(P<0.05)。术后1、3 d胆囊切除组血糖、CRP水平高于保胆取石组(P<0.05)。两组术后1、3 d血糖、CRP水平均高于术前1 d(P<0.05)。治疗方法与时间在ALT、AST、ALP、TBIL上不存在交互作用(P>0.05);治疗方法与时间在TP上存在交互作用(P<0.05);时间在ALT、AST、TBIL上主效应不显著(P>0.05);时间在ALP、TP上主效应显著(P<0.05);治疗方法在ALT、AST、ALP、TBIL上主效应不显著(P>0.05);治疗方法在TP上主效应显著(P<0.05)。术后1、3 d胆囊切除组TP高于保胆取石组(P<0.05)。术后1、3 d两组ALT、AST、ALP、TP及TBIL均高于术前1 d,术后7 d两组TBIL低于术前1 d(P<0.05)。两组平均随访时间比较,差异无统计学意义(t=0.798,P=0.427)。随访期间8例患者失访(胆囊切除组失访5例,保胆取石组失访3例),随访率为92.2%。两组术后结石复发率比较,差异无统计学意义(P>0.05)。胆囊切除组术后并发症发生率高于保胆取石组
Objective To discuss the response(including stress response and hepatic response)among elderly patients with cholecystolithiasis treated by laparoscopic cholecystectomy(LC)versus laparoscopic-choledochoscopic cholelithotomy(LCC).Methods We enrolled 102 elderly patients with cholecystolithiasis from Zhengzhou People's Hospital from June 2013 to December 2015 and assigned 62 undergoing LC and 40 undergoing LCC to LC group,and LCC group,respectively.We collected and compared their data about timing of postoperative first passage of flatus,use of analgesics,incidence of perioperative complications,length of stay(LOS),levels of fasting blood glucose(FBG),CRP,liver function indices(ALT,AST,ALP,TP,TBIL)measured at baseline(on the day before the surgery)and on the 1st,3rd,7th days after surgery,and recurrence of cholecystolithiasis.All of them were followed up as of December 30,2016.Results LCC group demonstrated lower use rate of analgesics compared with LC group(P<0.05).Both treatment regimen and duration exerted significant interaction effects on FBG and CRP(P<0.05).Moreover,they produced obvious main effects on FBG and CRP(P<0.05).FBG and CRP levels were increased in LC group on the 1st,3rd days after surgery(P<0.05).FBG and CRP levels were increased in both groups on the 1st,3rd days after surgery compared with baseline(P<0.05).Both treatment regimen and duration had significant interaction effects on TP level(P<0.05),but not on ALT,AST,ALP and TBIL levels(P>0.05).Treatment duration created significant main affects on ALP and TP level(s P<0.05),but not on ALT,AST and TBIL level(s P>0.05).Treatment regimen produced significant main affects on TP(P<0.05),but not on ALT,AST,ALP and TBIL levels(P>0.05).TP increased significantly in LC group on the 1st,3rd days after surgery compared with LCC group(P<0.05).Compared with baseline,ALT,AST,ALP,TP and TBIL increased substantially in both groups on the 1st,3rd days after surgery,and TBIL decreased notably in both groups on the 7th day after surgery(P<0.05).There was no differ
作者
陈涛
赵作伟
仝现州
王琨
张雷
刘磊
CHEN Tao;ZHAO Zuo-wei;TONG Xian-zhou;WANG Kun;ZHANG Lei;LIU Lei(Department of General Surgery,Zhengzhou People's Hospital,Zhengzhou 450000,China;Department of General Surgery,the Second Hospital of Dalian Medical University,Dalian 116044,China)
出处
《中国全科医学》
CAS
北大核心
2018年第12期1476-1480,共5页
Chinese General Practice
关键词
胆囊结石病
老年人
胆囊切除术
疗效比较研究
Cholecystolithiasis
Aged
Cholecystectomy
Comparative effectiveness research
